Consent and Release of Information for Research and Teaching Practices

Services with Emily Williams, LPC, MAC, AADC and Theresa Wheeler, LPC/S, LAC/S, MAC, CS include several activities including equine-assisted services. An existing partnership with HALTER, SC and several universities permits us to better serve you and our community. Collectively we participate in research projects with universities using de-identified data about our participants. The term “de-identified data” means that all 18 elements, listed below, are removed prior to data being released to researchers.

The primary purpose of all research conducted through these existing relationships is to determine changes in the measurements used from before a child begins to participate (or the first measure is taken for children who began participation prior to the collection of data), throughout the child’s participation in services. The analysis of the data allows us to work to continually improve the services we provide and increase positive impacts of those services for our participants. We also provide the outcomes of those measure for each child to the parent/guardian. This information can be shared with teachers, the school system, and treatment providers to help those individuals understand what changes, if any, are being recorded at HALTER or through Emily Williams.

• Names.
• All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census:
  a) The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people.
  b) The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000.
• All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older.
• Telephone numbers
• Facsimile numbers
• Electronic mail addresses
• Social security numbers
• Medical record numbers
• Health plan beneficiary numbers
• Account numbers
• Certificate/license numbers
• Vehicle identifiers and serial numbers, including license plate numbers
• Device identifiers and serial numbers
• Web universal resource locators (URLs)
• Internet protocol (IP) address numbers
• Biometric identifiers, including fingerprints and voiceprints
• Full-face photographic images and any comparable images
• Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re-identification.